Something To Chew On: How Can Physical Therapy Help My Jaw Pain?
By Michael Cyr, PT, DPT
Something to chew on
The jaw is the most active joint in the body opening and closing up to 2000 times a day to account for all of the eating, talking and breathing that we do (1,2). It is no wonder that disorders of this joint are the second most common occurring musculoskeletal condition only behind low back pain (3).
The jaw is made up of two bones, the temporal bone and mandible and is coined the temporal mandibular joint or TMJ for short. An intraarticular disc acts as cushion between the two bones and, when functioning correctly, allows for our mouths to smoothly open and close.
There are three main categories of TMD (temporomandibular disorders) involving these structures as well as the muscles that surround them.
Discal: Abnormal movement or positioning of the disc can lead to clicking of the jaw with mouth opening or closing. This can be painful and can sometimes lead to restrictions in motion or more severely trismus or “lock jaw”.
Muscular: Overuse, bruxism (teeth clenching), abnormal posture of the neck and back and emotional stress can all cause spasm or formation of painful trigger points in the muscles that help us open and close the jaw. Sometimes this pain be refereed to areas outside of where the cause is and may be interpreted as headache or facial pain.
Arthritic: The TMJ, like all other joints in the body can experience age and use related changes which lead to pain. Up to 50% percent of patients with RA or JRA develop symptoms in the TMJ, and women tend to be more affected than men (4).
Why physical therapy?
The Commission on Dental Accreditation does not require dental schools to teach the screening, assessment, diagnosis and management of TMD, meaning the average dentist may not be well equipped to identify and treat your jaw pain (5).
TMD also frequently appears in combination with neck pain, postural abnormalities and headaches which may need to be addressed in a comprehensive approach. An experienced physical therapist can offer evidence-based treatments including:
· Joint mobilization
· Myofascial release
· Trigger point dry needling
· Targeted stretching and exercise
· Relaxation and muscle sequencing techniques
· Postural correction
· Ergonomic recommendations
If you or someone you know is suffering from TMJ related pain have them call The Maine Strong Balance Center at 207-303-0612 for an evaluation by one of our qualified therapists.
1. Hoppenfeld S. Physical Examination of the Cervical Spine and Temporomandibular Joint. In: Physical Examination of the Spine and Extremities. Norwalk, CT: Appleton and Lange.1976. 105-132.
2. Magee DJ. Temporomandibular Joint. In: Orthopedic Physical Assessment, Magee ed. Philadelphia: WB Saunders Co, 1999, 152-174.
3. LiptonJA, Ship JA, LArach-Robinson D. Estimated prevalence and distribution of reported orofascial pain in the United States. J Am Dent Assoc 1993; q24: 115-121
4. Hertling D. The Temporomandibular Joint. In: Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 3rd edition. Darlene Hertling and Randolph M Kessler, eds. New York: Lippincott, 1996: 444-488.
5. H. Clifton Simmons III (2016) Why are dentists not trained to screen and diagnose temporomandibular disorders in dental school?, CRANIO®, 34:2, 76-78, DOI: 10.1080/08869634.2016.1140365
6. Fernández-de-las-Peñas, César, Juan Mesa-Jiménez, and Leon Chaitow. Temporomandibular Disorders: Manual Therapy, Exercise, and Needling. , 2018. Print.